AB0423 IMPROVEMENT OF ULTRASONOGRAPHIC FINDINGS IN JAK INHIBITOR TREATED JAPANESE RHEUMATOID ARTHRITIS PATIENTS COMPARISON WITH TNF INHIBITOR THERAPY
Authors: Y. Kanayama, A. Nagata, M. Shimotake, F. Miyachi, K. Fujita, M. Koyama, S. Uno, K. Hattori
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> JAK inhibitor (JAKi) and TNF inhibitor (TNFi) are the important therapeutic agent for the treatment of rheumatoid arthritis (RA). However there is still few studies of improvement of ultrasonographic findings in RA treats comparison with JAKi and TNFi. <h3>Objectives</h3> To evaluate the improvement of ultrasonographic findings in JAKi treated RA patients comparison with TNFi. <h3>Methods</h3> Participants comprised 40 and 43 Japanese RA patients who had recently received each JAKi (BAR26, PEF9, UPA5) and TNFi (CZP30, ADA5, ETN4, GLM4). All patients with a diagnosis of RA according to the 2010 ACR/EULAR criteria. Patients underwent clinical and laboratory assessments every 4 weeks from baseline to 24 weeks, and US assessments at baseline, 4, 12 and 24 weeks. Gray scale (GS) and power doppler (PD) signals were scored using a semi-quantitative scale from 0 to 3 at 26 (0-78) synovial sites (22 joints) in the following joints: bilateral first to fifth metacarpopharangeal (MCP) joints (dorsal recess); first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) (dorsal recess) joints; and the wrists (dorsal radial, median and ulnar). We evaluated the improvement of GS and PD score from baseline to week 24. <h3>Results</h3> In the patients receiving JAKi (n=40) and TNFi (n=43), the mean age was 56.0 vs 54.0 years old (p=0.514), disease duration was 7.3 vs 5.9 years (p=0.343), the rate of MTX use was 70% vs 86% (p=0.076), the mean MTX dose was 10.0 vs 9.9 mg/w (p=0.888), the rate of ACPA positive was 90% vs 79% (p=0.171), the rate of b/ts DMARDs naïve patients was 65% vs 91% (p=0.005), DAS28-ESR was 5.03 vs 4.69 (p=0.102), CDAI was 24.5 vs 19.2 (p=0.038), GS score was 22.1 vs 18.3 (p=0.535) and PD score was 15.1 vs 11.1 (p=0.625). The degree of improvement respective changes in GS and PD score from baseline to 4, 12 and 24 weeks were as follows: GS: -5.7 vs -4.7 (p=0.762) and PD: -6.6 vs -3.1 (p=0.489) after 4 weeks, GS: -9.3 vs -6.7 (p=0.975) and PD: -8.7 vs -4.6 (p=0.340) after 12 weeks, GS: -11.5 vs -9.7 (p=0.732) and PD: -9.5 vs -7.1 (p=0.802) after 24 weeks between JAKi and TNFi (Figure 1, 2). Next, The improvement rate of respective changes in GS and PD score after 4, 12 and 24 weeks were as follows: GS: -16.2% vs -20.7% (p=0.463) and PD: -29.7% vs -20.8% (p=0.414) after 4 weeks, GS: -30.2% vs -27.9% (p=0.884) and PD: -34.0% vs -33.0% (p=0.830) after 12 weeks, GS: -42.4% vs -39.4% (p=0.712) and PD: -41.6% vs -54.0% (p=0.865) after 24 weeks between JAKi and TNFi. Next, we evaluated the improvement of ultrasonographic findings between b/ts DMARDs naïve and switch, with and without MTX in the JAKi-treated patients. The degree of improvement respective changes in GS and PD score from baseline to 24 weeks were as follows: GS: -13.8 vs -7.1 (p=0.313) and PD: -10.8 vs -6.9 (p=0.334) between b/ts DMARDs naïve and switch patients, GS: -11.7 vs -11.0 (p=0.988) and PD: -9.2 vs -10.0 (p=0.658) between with and without MTX patients. <h3>Conclusion</h3> The present study provides evidence supporting the improvement in ultrasonographic findings in RA was similar for both JAKi and TNFi. Also In the JAKi-treated patients, similar improvement in ultrasonographic findings was observed regardless of whether the patients were naive or switch, with and without MTX. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Yasuhide Kanayama Speakers bureau: YK has received speakers' fees from AbbVie, Astellas, Asahi Kasei, Daiichi-Sankyo, Eisai, Eli Lilly, Ono and UCB Japan., Atsushi Nagata: None declared, Miyuki Shimotake: None declared, Fumiko Miyachi: None declared, Keisuke Fujita: None declared, Mai Koyama: None declared, Shiho Uno: None declared, Kyosuke Hattori: None declared.